Health Care Reform Provides Quality Care for Many More; Still Needs Our Support

February 2011

The Patient Protection and Affordable Care Act (ACA), or health care reform, was signed into law March 2010. This milestone represents the most important advance in secure, quality health care for people with HIV since the start of the Ryan White Program. However, this historic health care expansion is now under serious attack by those who would roll it back by taking advantage of misunderstandings and negative propaganda about reform. We cannot afford to let this hard-won victory be dismantled or underfunded. Each of us has an important role to play in dfending health care reform and ensuring a successful implementation.

Most people still don't understand the ACA even as it is already making a dramatic improvement in many people's lives and health. Significant activity is already underway to allow expanded insurance coverage to upwards of 32 million uninsured Americans. by 2014 people will be guaranteed access to quality insurance regardless of their health status, a required package of essential benefits, significant assistance to low-income people to get insurance, and caps on the out-of-pocket costs most Americans pay.

You can help defend health care reform by educating yourself and your loved ones about the benefits of the ACA already in place and those to come in 2014. You can also contact your elected officials in Congress and let them know why you support the ACA and how it will make a difference in your life and your health.

Already, health care reform has ensured that:

Health plans can no longer impose lifetime or annual limits on coverage. Many people with HIV suffered with plans that did not cover the cost of their care due to caps and limitations.

Health plans must cover children (under 19) with pre-existing conditions.

All young adults are allowed to stay on their parents' insurance policies until they are 26, giving them time to finish schooling and establish insurance through their employer.

Insurance companies must justify their premium rates and increases.

All newly sold insurance plans are required to cover certain prevention and wellness benefits with no deductibles or cost-sharing.

Insurance companies are required to spend 80-85% of the premiums they collect on health care services and improvements in the quality of care or they must provide refunds to beneficiaries. Many companies are considering expanding their benefits and possibly providing refunds to meet the requirements.

Insurance companies are no longer able to take away policies when people get sick.

Certain people with pre-existing conditions, including HIV, have access to a temporary insurance program (Pre-existing Condition Insurance Programs or PCIPs) with premium rates that are consistent with rates for those without pre-existing conditions. This program will remain intact until 2014 when the expansion of Medicaid and the establishment of Health Insurance Exchanges will provide much more coverage.

Medicare beneficiaries who reached the coverage gap in 2010, almost all people with HIV who depend on Medicare, received a $250 rebate.

As of January 2011, Medicare beneficiaries will receive a 50% discount on brand name drugs in the coverage gap. This is significant for people with HIV who typically reach the coverage gap in the second or third month of coverage.

As of January 2011, AIDS Drug Assistance Program (ADAP) payments for Medicare prescription drugs will begin to count toward allowing a beneficiary to move through the coverage gap to meaningful drug coverage. People with HIV who rely on Medicare and ADAP will, for the first time, be able to take advantage of their full Medicare benefit rather than relying entirely on ADAP for most of the plan year.

Small businesses receive tax credits to provide health insurance to their employees.

In 2014, many significant protections and expansions in coverage will be enacted:

Medicaid will be expanded to serve all low income individuals at 133% of the FPL regardless of disability status. For the first time most low-income people with HIV will be able to get Medicaid coverage before they become sick. The asset test for Medicaid will also be eliminated and a new package of essential benefits, including prescription drugs, will be mandatory for new beneficiaries.

Medicare drugs will continue to become more affordable until the coverage gap is eliminated in 2020.

Health exchanges, regulated marketplaces for purchasing insurance, will be enacted at the state level. Insurance companies will be required to have a much greater level of transparency with their benefits and will have to provide at a minimum an essential package of benefits. States will have new authority to regulate plans in their exchanges. All of these provisions could ensure more competition among insurers and give people the opportunity to purchase better plans at the better prices.

Out-of-pocket expenses related to health care coverage will be capped, providing peace of mind for people with HIV and others with extensive medical needs. Subsidies will be provided for people with incomes up to 400% of the Federal Poverty Level (FPL.).

Insurance companies will be required to provide coverage to people who have pre-existing conditions at rates that are the same as others in the community.

Insurance companies will not be able to discriminate or charge higher rates based on gender and will be limited in charging more for age or geographic location.

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People who currently have insurance sometimes find it hard to see how health reform will help them. However, health care reform not only provides new coverage for people who are uninsured, it also provides much needed security for those who are already insured.

For the first time, people will not be tied to their jobs for fear of losing health insurance coverage for themselves or a family member and for their families. Many people currently stay in jobs or fear lay-offs and company closures primarily because they will be unable to get insurance for themselves or their family.

Insurance companies can no longer take away your coverage if you get sick. The elimination of discrimination against those with pre-existing conditions (which can include such seemingly inconsequential conditions as varicose veins as well as more serious conditions such as HIV), subsidies in exchanges, and Medicaid expansion should mean that people who lose or change jobs will, at a minimum, keep their health insurance.

The cap on out-of-pocket expenses and the prohibition on lifetime and annual caps will provide much needed security to Americans with high medical costs. Currently excessive medical costs are the leading reason for bankruptcy in the United States.

Now is the time to understand and take advantage of the benefits of health reform that have already been enacted. It is also critical to defend health care reform against attempts in Congress to repeal, defend and/or dismantle health care reform. Contact your elected officials and tell them how health care reform will improve your life and your health and that of those you love. If health care reform is fully implemented all of us will benefit from the same access to secure affordable health insurance enjoyed by members of Congress and their families.

This article was provided by Project Inform. It is a part of the publication Project Inform Perspective.
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